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General NPI Number Information
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NPI Number | 1881451565
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Entity Type | Individual
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Provider Name | MELISSA LEE HASELTINE LADC
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Gender | Female
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 817 MAIN ST N
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1275
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Country | US
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Telephone | 763-325-0300
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Fax | 763-325-0301
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 307361
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License Number State | MN
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